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Ong YJ, Meyer B, Quek YTE, Wong ML, Hong CHL, Hu S. Perception of nurses applying silver diamine fluoride to children's teeth: A mixed methods study. Int J Paediatr Dent 2024. [PMID: 38229230 DOI: 10.1111/ipd.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/11/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND No studies have evaluated the unique potential of nurse-led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration. AIM To investigate the attitudes, beliefs and perceptions of nurses regarding nurse-led SDF application at the well-child visit and identify possible barriers and make recommendations. DESIGN Mixed methods design involving a questionnaire and semi-structured individual interviews were conducted. RESULTS All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations. CONCLUSION Where nurses are already providing basic oral healthcare, nurse-led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well-child visit.
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Affiliation(s)
- Yu Jie Ong
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
- Restorative Department, National Dental Centre Singapore, Singapore City, Singapore
| | - Beau Meyer
- Division of Paediatric Dentistry, College of Dentistry, Ohio State University, Columbus, Ohio, USA
| | - Yu Ting Eline Quek
- National University Polyclinics, National University Health System, Singapore City, Singapore
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
| | | | - Shijia Hu
- Faculty of Dentistry, National University of Singapore, Singapore City, Singapore
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Lienhart G, Elsa M, Farge P, Schott AM, Thivichon-Prince B, Chanelière M. Factors perceived by health professionals to be barriers or facilitators to caries prevention in children: a systematic review. BMC Oral Health 2023; 23:767. [PMID: 37853400 PMCID: PMC10585780 DOI: 10.1186/s12903-023-03458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Considered the most prevalent noncommunicable disease in childhood, dental caries is both an individual and a collective burden. While international guidelines highlight prevention as a major strategy for caries management in children, health professionals still struggle to implement prevention into their clinical practice. Further research is needed to understand the gap between the theoretical significance of dental prevention and its lack of implementation in the clinical setting. This systematic review aims to identify and classify factors perceived by health professionals to be barriers or facilitators to caries prevention in children. METHOD A systematic literature search was conducted in three electronic databases (Medline, Web of Science and Cairn). Two researchers independently screened titles, abstracts and texts. To be selected, studies had to focus on barriers or facilitators to caries prevention in children and include health professionals as study participants. Qualitative and quantitative studies were selected. The factors influencing caries prevention in children were sorted into 3 main categories (clinician-related factors, patient-related factors, and organizational-related factors) and then classified according to the 14 domains of the theoretical domains framework (TDF). RESULTS A total of 1771 references were found by combining manual and database searches. Among them, 26 studies met the inclusion criteria, of which half were qualitative and half were quantitative studies. Dentists (n = 12), pediatricians (n = 11), nurses (n = 9), and physicians (n = 5) were the most frequently interviewed health professionals in our analysis. Barriers and facilitators to caries prevention in children were categorized into 12 TDF domains. The most frequently reported domains were Environmental Context and Resources, Knowledge and Professional Role and Identity. CONCLUSION This systematic review found that a wide range of factors influence caries prevention in children. Our analysis showed that barriers to pediatric oral health promotion affect all stages of the health care system. By highlighting the incompatibility between the health care system's organization and the implementation of caries prevention, this study aims to help researchers and policy-makers design new interventions to improve children's access to caries prevention. TRIAL REGISTRATION PROSPERO CRD42022304545.
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Affiliation(s)
- Guillemette Lienhart
- Service d'Odontologie, Hospices Civils de Lyon, 6/8 Place Deperet, 69007, Lyon, France.
| | - Masson Elsa
- Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France
| | - Pierre Farge
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
| | - Anne-Marie Schott
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
| | | | - Marc Chanelière
- Research On Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Domaine Rockefeller, 8 Avenue Rockefeller, 69373, Lyon 8, France
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Pike NA, Kinsler JJ, Peterson JK, Verzemnieks I, Lauridsen L, Love-Bibbero L, Ramos-Gomez F. Improved oral health knowledge in a primary care pediatric nurse practitioner program. J Am Assoc Nurse Pract 2022; 34:755-762. [PMID: 35102094 DOI: 10.1097/jxx.0000000000000696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pediatric nurse practitioners (PNPs) are a significant workforce in primary care and are uniquely positioned to improve oral health in children through ongoing surveillance in the well-child visit. The purpose of this study was to evaluate PNP student satisfaction and knowledge gained with the integration of the Strategic Partnership for Interprofessional Collaborative Education in Pediatric Dentistry (SPICE-PD) oral health education program into the first-year primary care curriculum. A descriptive, comparative design examined dental test scores across the pre-SPICE-PD (2013-2014; n = 26) and post-SPICE-PD (2015-2020; n = 55) cohorts. An electronic survey was completed (n = 47; 67%), and focus group (n = 12) audio-recordings were analyzed using Atlas.ti 8.0. Chi-square test and independent samples t-test were used to assess differences between groups. The SPICE-PD students reported improved knowledge and skill in clinical practice. Focus group themes were oral health education was beneficial, impact of coronavirus disease 2019, and suggestions for improvement. Mean dental test scores improved pre- and post-SPICE-PD (83 vs. 93; p < .001). The SPICE-PD oral health education improved knowledge and was highly satisfying for students. Pediatric nurse practitioners are ideally positioned to integrate oral health into primary care services, thereby improving access to care and ultimately reducing or mitigating early childhood caries. Evaluation of PNP postgraduation practices in the primary care setting is needed to assess whether improved knowledge results in practice change.
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Affiliation(s)
- Nancy A Pike
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Janni J Kinsler
- School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | | | - Inese Verzemnieks
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Lauren Lauridsen
- School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Laurie Love-Bibbero
- School of Nursing, University of California, Los Angeles, Los Angeles, California
| | - Francisco Ramos-Gomez
- Division of Pediatric Dentistry, School of Dentistry, University of California, Los Angeles, Los Angeles, California
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Grant S, Affoo R, Mitchell C, Brillant M, MacCallum T, Hachey S. Oral Health–Related Knowledge, Attitudes, and Practice Patterns of Nurse Practitioners: A Mixed Methods Study. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Pourat N, Martinez AE, Haley LA, Crall JJ. Colocation Does Not Equal Integration: Identifying and Measuring Best Practices in Primary Care Integration of Children's Oral Health Services in Health Centers. J Evid Based Dent Pract 2020; 20:101469. [PMID: 33303098 DOI: 10.1016/j.jebdp.2020.101469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 05/22/2020] [Accepted: 06/20/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Improving oral health of low-income and uninsured young children remains challenging because of reluctance of general dentists to care for very young children or participate in Medicaid, limited involvement of primary care providers in children's oral health, and lack of parental awareness of the importance of early oral health care. These barriers can be addressed in health centers (HCs) that are the premier sources of primary care for low-income and uninsured populations and a significant Medicaid provider. Many HCs provide dental services on-site, but literature indicates that medical and dental services often remain siloed with limited interaction among providers in addressing the oral health needs of young patients including risk assessment, education, and caries prevention. Accordingly, we developed a conceptual framework and measuring tool for medical dental integration and sought to examine utility of this tool in a purposive sample of HCs. METHOD We developed a conceptual framework for integrated oral health delivery and designed a survey to measure this integration. We surveyed 12 HCs in Los Angeles County participating in a project to improve oral health-care capacity for young children after 2 years of implementation. We included measures of risk assessment, preventive interventions, communication and collaborative practice, and buy-in organized in structure and process domains. Two individuals independently scored the responses, and a third reviewed and finalized. We standardized final scores to range from 0 to 100. RESULTS Overall integration scores ranged from 31% to 73% (mean = 64%). Process scores were higher than structure scores for nearly all HCs. Processes contributing to higher scores included referrals with warm hand-offs, leadership support for medical-dental integration, and involvement in dental quality improvement projects. Structure factors contributing to higher scores included the presence of medical oral health champions, linked electronic health records, and referral protocols. CONCLUSION We found that high levels of integration could be achieved despite structure and process limitations and sustainable integration depends on leadership and provider commitment and embedding of best practices in daily operations. Further research can illustrate the reliability of our tool and the impact of integration on access.
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Affiliation(s)
- Nadereh Pourat
- UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA; UCLA School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Ana E Martinez
- UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA
| | - Leigh Ann Haley
- UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, CA, USA
| | - James J Crall
- UCLA School of Dentistry, University of California, Los Angeles, Los Angeles, CA, USA
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Hachey S, Clovis J, Lamarche K. Children's Oral Health and Barriers to Seeking Care: Perspectives of Caregivers Seeking Pediatric Hospital Dental Treatment. ACTA ACUST UNITED AC 2020; 15:29-39. [PMID: 31629454 PMCID: PMC7008694 DOI: 10.12927/hcpol.2019.25940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To investigate the demographics of children (and their caregivers) requiring hospital-based tertiary dental care, oral health services use and perceptions of and barriers to oral healthcare in Nova Scotia. Method: A questionnaire was administered to caregivers (N = 62) on behalf of their child (N = 62). Results: Nearly half (45.8%, N = 27) of the caregivers experienced difficulty seeking oral healthcare for both themselves and their children. Less than a quarter (23.2%, N = 13) of the caregivers sought care for their child by the recommended age of one (mean age of first visit = 2.69 years). Alternate delivery in a school, community or primary healthcare setting was preferred by 53.3% (n = 32) of the caregivers for children's oral healthcare. Low-income families (53.8%, n = 28), rural areas (47.4%, n = 27) and Indigenous children (9.7%, n = 6) were over-represented in the study's sample. Conclusion: Socio-economically disadvantaged populations are more vulnerable to oral diseases. Oral health of priority populations in Nova Scotia appears to be inadequately addressed.
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Affiliation(s)
- Shauna Hachey
- Assistant Professor, School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS
| | - Joanne Clovis
- Professor Emeritus, School of Dental Hygiene, Faculty of Dentistry, Dalhousie University, Halifax, NS
| | - Kimberley Lamarche
- Associate Professor, Faculty of Health Disciplines, Athabasca University, Athabasca, AB
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Nancy J, Barsby T, Theillaud M, Barbey-Massin C, Thébaud NB. Early childhood caries prevention: non-dental health professionals' viewpoint. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:884-890. [PMID: 32790547 DOI: 10.12968/bjon.2020.29.15.884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dental caries can develop early in life and have harmful consequences. Objective: To examine non-dental practitioners' knowledge of early childhood caries (ECC). METHODS A questionnaire on oral health and caries knowledge was emailed to five types of health professional who work with young children: paediatricians, GPs, midwives, paediatric nurses and paediatric healthcare assistants. Questions concerned: when a child should first visit a dentist; at what age toothbrushing should start; aetiopathogenic factors; early diagnosis; and the effect of breastfeeding. RESULTS 494 health professionals (79 paediatricians, 59 physicians, 217 midwives, 92 paediatric nurses and 47 paediatric healthcare assistants) participated. Although most (89.86%) discussed oral health with parents, responses on when a child should first see a dentist and when toothbrushing should start varied. Almost half of respondents said they could diagnose caries but not all were confident in this. Aetiological factors in ECC mentioned included oral hygiene, bottle feeding, sugar intake, genetics and a lack of fluoride. CONCLUSION Non-dental practitioners lack knowledge about ECC, so cannot help prevent it. Initiatives including interprofessional training would improve their knowledge of oral health in early childhood.
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Affiliation(s)
- Javotte Nancy
- Université de Bordeaux, UFR des Sciences Odontologiques, Bordeaux, and CHU de Bordeaux, Service d'Odontologie et de Santé Buccale, Bordeaux, France
| | | | - Marie Theillaud
- Université de Bordeaux, UFR des Sciences Odontologiques, Bordeaux, France
| | | | - Noëlie-B Thébaud
- Université de Bordeaux, UFR des Sciences Odontologiques, Bordeaux, CHU de Bordeaux, Service d'Odontologie et de Santé Buccale, Bordeaux, and INSERM, Bioingénierie Tissulaire, Bordeaux, France
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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Estes KR, Callanan D, Rai N, Plunkett K, Brunson D, Tiwari T. Evaluation of an Interprofessional Oral Health Assessment Activity in Advanced Practice Nursing Education. J Dent Educ 2018; 82:1084-1090. [PMID: 30275143 DOI: 10.21815/jde.018.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/06/2018] [Indexed: 12/22/2022]
Abstract
The curriculum for nurse practitioner (NP) students often overlooks the assessment of the oral cavity. In recognition of this, the HEENT (head, eyes, ears, nose, and throat) assessment was expanded to HEENOT (head, ears, eyes, nose, oral, and throat) through integration of an interprofessional educational (IPE) activity developed for University of Colorado NP and dental students. The aim of this study was to assess NP students' perceptions of an IPE activity in which dental faculty and students taught NP students how to conduct an oral exam, recognize oral health pathology, and apply fluoride varnish. Afterwards, the NP students completed an evaluation survey focusing on their thoughts, comfort level, organization, and understanding of the activity. This IPE activity was repeated over four semesters from 2014 to 2017, and significant differences among the semesters were compared. All NP students in the four semesters participated in the activity and the survey: semester one N=25, semester two N=31, semester three N=43, and semester four N=25. In all semesters, NP students reported feeling more confident conducting oral health exams after completion of the IPE activity. Semester four students agreed more with the idea of interprofessional collaboration (OR: 0.103) and receiving educational information not learned elsewhere in the curriculum (OR: 0.134) compared to semester one students. Higher odds for the session being well organized and conducted in a suitable time were found for semester four compared to semester two (OR: 0.217). These comparisons reflect improvement in teaching methodologies over the four semesters and an overall increased confidence for NP students in performing an oral health assessment.
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Affiliation(s)
- Krista R Estes
- Krista R. Estes, DNP, FNP-C, is Associate Professor and Family Nurse Practitioner Specialty Director, University of Colorado College of Nursing; Deidre Callanan, RDH, DC, MPH, is Clinical Instructor, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Nayanjot Rai, MPH, BDS, is Professional Research Assistant, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Katie Plunkett, MS, works at the University of Colorado School of Dental Medicine; Diane Brunson, RDH, MPH, works at the University of Colorado School of Dental Medicine; and Tamanna Tiwari, MPH, BDS, MDS, is Assistant Professor, Department of Community Dentistry and Population Health, School of Dental Medicine, and Associate Director, Center for Oral Disease Prevention and Population Health Research, University of Colorado.
| | - Deidre Callanan
- Krista R. Estes, DNP, FNP-C, is Associate Professor and Family Nurse Practitioner Specialty Director, University of Colorado College of Nursing; Deidre Callanan, RDH, DC, MPH, is Clinical Instructor, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Nayanjot Rai, MPH, BDS, is Professional Research Assistant, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Katie Plunkett, MS, works at the University of Colorado School of Dental Medicine; Diane Brunson, RDH, MPH, works at the University of Colorado School of Dental Medicine; and Tamanna Tiwari, MPH, BDS, MDS, is Assistant Professor, Department of Community Dentistry and Population Health, School of Dental Medicine, and Associate Director, Center for Oral Disease Prevention and Population Health Research, University of Colorado
| | - Nayanjot Rai
- Krista R. Estes, DNP, FNP-C, is Associate Professor and Family Nurse Practitioner Specialty Director, University of Colorado College of Nursing; Deidre Callanan, RDH, DC, MPH, is Clinical Instructor, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Nayanjot Rai, MPH, BDS, is Professional Research Assistant, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Katie Plunkett, MS, works at the University of Colorado School of Dental Medicine; Diane Brunson, RDH, MPH, works at the University of Colorado School of Dental Medicine; and Tamanna Tiwari, MPH, BDS, MDS, is Assistant Professor, Department of Community Dentistry and Population Health, School of Dental Medicine, and Associate Director, Center for Oral Disease Prevention and Population Health Research, University of Colorado
| | - Katie Plunkett
- Krista R. Estes, DNP, FNP-C, is Associate Professor and Family Nurse Practitioner Specialty Director, University of Colorado College of Nursing; Deidre Callanan, RDH, DC, MPH, is Clinical Instructor, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Nayanjot Rai, MPH, BDS, is Professional Research Assistant, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Katie Plunkett, MS, works at the University of Colorado School of Dental Medicine; Diane Brunson, RDH, MPH, works at the University of Colorado School of Dental Medicine; and Tamanna Tiwari, MPH, BDS, MDS, is Assistant Professor, Department of Community Dentistry and Population Health, School of Dental Medicine, and Associate Director, Center for Oral Disease Prevention and Population Health Research, University of Colorado
| | - Diane Brunson
- Krista R. Estes, DNP, FNP-C, is Associate Professor and Family Nurse Practitioner Specialty Director, University of Colorado College of Nursing; Deidre Callanan, RDH, DC, MPH, is Clinical Instructor, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Nayanjot Rai, MPH, BDS, is Professional Research Assistant, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Katie Plunkett, MS, works at the University of Colorado School of Dental Medicine; Diane Brunson, RDH, MPH, works at the University of Colorado School of Dental Medicine; and Tamanna Tiwari, MPH, BDS, MDS, is Assistant Professor, Department of Community Dentistry and Population Health, School of Dental Medicine, and Associate Director, Center for Oral Disease Prevention and Population Health Research, University of Colorado
| | - Tamanna Tiwari
- Krista R. Estes, DNP, FNP-C, is Associate Professor and Family Nurse Practitioner Specialty Director, University of Colorado College of Nursing; Deidre Callanan, RDH, DC, MPH, is Clinical Instructor, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Nayanjot Rai, MPH, BDS, is Professional Research Assistant, Department of Community Dentistry and Population Health, University of Colorado School of Dental Medicine; Katie Plunkett, MS, works at the University of Colorado School of Dental Medicine; Diane Brunson, RDH, MPH, works at the University of Colorado School of Dental Medicine; and Tamanna Tiwari, MPH, BDS, MDS, is Assistant Professor, Department of Community Dentistry and Population Health, School of Dental Medicine, and Associate Director, Center for Oral Disease Prevention and Population Health Research, University of Colorado
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